Neighborhood Networks
Description
Neighborhood Networks assists individuals and families undergoing chronic health conditions or who have otherwise identified by their health plan as needing further care coordination to improve overall wellbeing by addressing the broader context affecting health.
Services
Intensive case management and connections to additional resources within the community.
Eligibility
Determined by the health plan and includes meeting specified chronic conditions and at least 1 of 4 acuity criteria. All potential clients must have Medi-Cal health insurance and they must belong to one of the specific managed care health plans (Community Health Group, Health Net, Molina, or Blue Shield of California). People enrolled in both Medicare and Medi-Cal (aka: Medi-Medi) are not eligible.
Adults/Youth must also be identified as (ECM Populations):
Considered high utilizers of care: those who have had 5+ emergency department visits or 3+ unplanned hospital or short-term skilled nursing facility stays in the last 6 months, or those who have been identified by their health plan as having a pattern of high utilization that could have been avoided.
Experiencing homelessness and have at least one complex physical, behavioral, or developmental health need.
Please refer to the referral form below for a step-by-step screening tool to see if your client is eligible.
Service Areas
North Central, Central, and South regions.
Points of Contact
Andria Del Real at adelreal@saysandiego.org or 619-283-9624 ext 323
Taking New Referrals
Yes, currently taking new referrals. Referral form also has a screening component. Clients may self-refer if eligible under the ECM populations AND have coverage under one of the contracted health plans (Blue Shield Promises [BSP], Health Net, Molina, or Community Health Group [CHG]). Send referrals to referrals@sdwellnesscollaborative.org.
Referral Form:
https://docs.google.com/document/d/1f0CgmxfpIjOblC7KkI8Q-QOeJLxZQkKcy8Y6eVV5kzI/edit?usp=sharing
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KEYWORDS
Medi-Cal, Care Coordination, Case Management, Housing, Health, Resource Navigation